Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

Ministry spokesman Edmilson Oliveira da Silva said the government would not appeal Wednesday’s ruling by a panel of federal judges giving the government 30 days to offer the procedure or face fines of $5,000 a day.

“The health minister was prompted by the judges’ decision,” Silva said. “But we already had a technical group studying the procedure with the idea of including it among the procedures that are covered.”

Federal prosecutors from Rio Grande do Sul state had argued that sexual reassignment surgery is covered under a constitutional clause guaranteeing medical care as a basic right.

On Wednesday the 4th Regional Federal Court agreed, saying in its ruling that “from the biomedical perspective, transsexuality can be described as a sexual identity disturbance where individuals need to change their sexual designation or face serious consequences in their lives, including intense suffering, mutilation and suicide.”

The Health Ministry said it would be up to local health officials to decide who qualifies for the surgery and what priority it will be given compared with other operations within the public health system.

Patients must be at least 21 years old and diagnosed as transsexuals with no other personality disorders and must undergo psychological evaluation for at least two years, the ministry said.

“Transsexuals represent about 0.001 percent of the Brazilian population, but for this minority, sexual reassignment surgery is a question of life and death,” said Luiz Mott, founder of the Bahia Gay Group. “It is unjust and cruel to argue that the health system should concern itself with other priorities.”

So far the measure has not prompted any opposition.

Brazil’s public health system offers free care to all Brazilians, including a variety of surgeries and free AIDS medication. But long lines and poorly equipped facilities mean that those who can afford it usually choose to pay for private hospitals and clinics.

The health ministry said that since 2000, about 250 sexual reassignment surgeries considered experimental have been performed at three university hospitals.

Brazil is generally more tolerant of homosexuality than other Latin American countries, with transvestites featured prominently in celebrations like carnival, but discrimination still exists.